Vizzardi Enrico, Bonadei Ivano, Rovetta Riccardo, Sciatti Edoardo, D'Aloia Antonio, Pezzali Natalia, Salghetti Francesca, Curnis Antonio, Metra Marco
Department of Medical and Surgical, Radiological Sciences and Public Health Specialty, Section of Cardiovascular Diseases, University of Study of Brescia, Brescia, Italy.
J Cardiovasc Med (Hagerstown). 2015 May;16(5):326-30. doi: 10.2459/JCM.0b013e328364e710.
Tako-Tsubo cardiomyopathy (TTC) is an acute cardiomyopathy mimicking acute myocardial infarction. The aim of our study was to define clinical and instrumental features of an Italian population of patients with TTC and to report their short and mid-term outcome.
We retrospectively evaluated 42 patients admitted to our Department with diagnosis of TTC (100% women, age 67 ± 11 years) using Mayo Clinic-modified criteria. In this population, we analyzed the stressful event (if present), the clinical presentation, the ECG and echocardiogram at admission and the markers of myocardial cytonecrosis, such as troponin I, at admission and during the hospitalization. All the patients have been clinically evaluated after 6 months and 1 year of follow-up.
In this population, a stressful event before TTC has been detected in 59% of patients. The most common clinical presentation was chest pain (81%) and the major sign was dyspnea (17%). ECG showed negative T waves and ST elevation, respectively, in 45 and 38%. Only 10% had a ST depression and 7% developed a newly acquired complete left bundle branch block. All of these abnormalities disappeared within 1.8 ± 0.9 days. The mean ejection fraction at admission was 35 ± 7% associated with apical (40%), mid-apical (56%) and mid-ventricular (4%) wall motion abnormalities. The recovery of these abnormalities occurred within 10 ± 3 days. At 6-month and 1-year follow-up, no patients had TTC recurrence, and 10 patients at 6 months and 20 patients at 1 year were re-hospitalized for a non-cardiac cause.
Our data describe the characteristics of TTC in a small Italian population, which are similarly described in Japanese and North American people. TTC was related to a very low mortality, both in the short and mid term, but the risk of acute heart failure in the acute phase could not be neglected.
应激性心肌病（TTC）是一种酷似急性心肌梗死的急性心肌病。我们研究的目的是明确意大利TTC患者群体的临床和影像学特征，并报告其短期和中期预后。
我们使用梅奥诊所修订标准，对42例被诊断为TTC并入住我科的患者（100%为女性，年龄67±11岁）进行回顾性评估。在该群体中，我们分析了应激事件（若存在）、临床表现、入院时的心电图和超声心动图，以及入院时和住院期间心肌细胞坏死标志物，如肌钙蛋白I。所有患者在随访6个月和1年后均接受了临床评估。
在该群体中，59%的患者在TTC发作前存在应激事件。最常见的临床表现为胸痛（81%），主要体征为呼吸困难（17%）。心电图分别显示T波倒置和ST段抬高的比例为45%和38%。仅有10%的患者出现ST段压低，7%的患者新发完全性左束支传导阻滞。所有这些异常在1.8±0.9天内消失。入院时平均射血分数为35±7%，伴有心尖部（40%）、心尖中部（56%）和心室中部（4%）室壁运动异常。这些异常在10±3天内恢复。在6个月和1年随访时，无患者TTC复发，6个月时10例患者和1年时20例患者因非心脏原因再次住院。
我们的数据描述了一小部分意大利TTC患者的特征，日本人和北美人群也有类似描述。TTC在短期和中期死亡率均很低，但急性期急性心力衰竭的风险不可忽视。
